Qualitative Investigation of Successful First Time Passing of the Npte in Six Consecutive Dpt Cohorts
Background and Purpose:
Not passing the National Physical Therapy Exam (NPTE) has significant consequences. If a student does not pass the NPTE on the first attempt they can retake the examination, however a student may only take the examination a maximum of three times in any 12-month period and there is a 6-time lifetime limit on NPTE attempts.
The purpose of this study was to look at qualitative variables (including hidden curriculum, culture, and curriculum) that may be potential factors for student success to determine their impact on successful first time passing of the NPTE within the case boundaries of the University of New Mexico DPT 2012 -2017 cohorts.
Hidden curriculum teaching occurs, in part, through interpersonal interactions between faculty, near-peers and peers and clinical instructors (Hafferty & O’Donnell, 2014, Chapter 11). Student treatment and mistreatment, feedback and evaluation are all a part of the culture of the hidden curriculum (Hafferty & O’Donnell, 2014).
Case Description:
The sample consisted of all six cohorts of the DPT (n=167) from 2012-2017. I used a stratified random sample of each cohort. The stratification was created based on the mean National NPTE score ± 1 standard deviation of the NPTE for that particular cohort year. I created three strata in each cohort year. From each UNM cohort (n=6), I randomly selected one student from each of the three following strata for a total of 18 (3 criteria x 6 cohorts):
1) Those who were 1 standard deviation below the national mean,
2) Those that scored within one standard deviation above and below the national mean,
3) Those that scored above one standard deviation from the National mean.
All eighteen interviews were audio recorded with verbatim transcriptions. Transcripts were sent back to participants for verification. Emergent themes were coded with key words and phrases
Within the random sample this stratified sampling technique created, I successfully captured a few graduates who did not pass the NPTE on the first attempt. Within the entire sample of 167 graduates there were 9% that did not pass the NPTE on their first attempt. Of interest, in my stratified sampling I came as close to that as possible, having 11% of my stratified interview sample consist of those who did not pass the NPTE on their first attempt. I also successfully mirrored the gender split of my larger group. The large sample of all 167 graduates was 70% female. My stratified random sample ended up being 66.6% with 12 females and 6 males.
Outcomes:
Graduates expressed that they felt that the formal curriculum prepared them well for the NPTE.
Graduates felt that they could trust the faculty. They highlighted that the faculty helped motivate them to do well, that the faculty supported them, and that they were flexible and gave quality instruction.
Graduates found value in the board prep class, the STEP exams and the PEAT and felt that all prepared them to be successful on their first attempt at the NPTE. Graduates also expressed the importance of and the need for the exams to be high stakes to truly simulate the NPTE.
The physical space and resources of the campus contributed to the graduate’s success.
Group study was a significant part of their experience. Most graduates added group study to be successful in the program and in taking the NPTE. Most had not used group study during their undergraduate education.
Study groups often reflected a recognition of learning style and many looked for diverse learning styles when forming their group.
For the graduates who struggled to pass the NPTE, there was a general report that they often did not study in groups. They also tended to reflect a fixed mindset related to failure. They revealed that this fixed mindset occurred within and after the program. They recognized that to eventually be successful and pass the NPTE that they had to change their mindset.
All graduates reported having a sense of belonging and a familial feeling related to their cohort and to the program.
Discussion:
This study confirms the presence of a hidden curriculum in physical therapy education. Graduate reflection indicated that the hidden curriculum was thought to be a large reason for their success on the NPTE. For these graduates, the emphasis of the hidden curriculum was on the interpersonal relationships with faculty and the supportive campus atmosphere that made them feel comfortable and at home. All graduates reported having a sense of belonging and a familial feeling related to their cohort and to the program. Graduates felt that they could trust the faculty and related that they knew that they could trust what was being taught to them. They highlighted that the faculty helped motivate them to do well and that the faculty supported them as individuals. They reported that the faculty was available, flexible, and delivered quality instruction.
An unexpected finding was the influence of mindset. My interviews with those who were not successful in passing the NPTE revealed a notable commonality, a fear of failure. These graduates related that this fear began within the program. This fixed mindset, that failure was not acceptable, created an isolation effect for the graduates.